Category Archives: Medicaid Fraud Division

Tuesday, September 5, 2017

BOSTON – The U.S. Attorney’s Office and the Massachusetts Attorney General’s Office announced today that Dental Dreams, LLC, a national dental chain with locations in Massachusetts, has agreed to pay $1.375 million to resolve allegations that it improperly billed the Massachusetts Medicaid program (MassHealth) for unnecessary and unjustifiable dental procedures.

“Dental Dreams enriched itself at taxpayer expense by improperly billing Medicaid,” said Acting U.S. Attorney William D. Weinreb. “We will continue to work with our law enforcement partners to ensure that federal and state health care dollars are spent properly.”

“This dental chain’s extensive improper billing violated state regulations and cost our state’s Medicaid program more than a million dollars,” said Massachusetts Attorney General Maura Healey. “As a result of this joint investigation, today’s settlement provides restitution to MassHealth and ensures that these funds are properly used to benefit its members.”

“Medicaid is designed to provide health care services to some of the most vulnerable members of our society and it’s our agency’s mission to ensure government health funds are spent properly,” said Special Agent in Charge Phillip M. Coyne of the U.S. Department of Health and Human Services Office of Inspector General. “Working with our Federal and State partners, we will continue to hold accountable any medical professional who, just to enrich themselves, bills Medicaid for more intensive and expensive services than those actually provided.”

“The company took advantage of a vulnerable patient population when it submitted claims to MassHealth for medically unnecessary and unreasonable dental procedures,” said Harold H. Shaw, Special Agent in Charge of the Federal Bureau of Investigation, Boston Field Division. “Today’s settlement underscores the FBI’s commitment to investigate health care providers who overbill federal and private health insurance programs to maximize profits. We urge anyone with information regarding overbilling practices to contact us.”

The settlement resolves allegations that Dental Dreams overbilled the Massachusetts Medicaid program for surgical extractions of teeth and for a specific kind of oral examination.

The settlement resolves a lawsuit filed by a former employee under the whistleblower provisions of the False Claims Act, which permits private parties to sue on behalf of the government for false claims for government funds and to receive a share of any recovery.

August 21, 2017

BOSTON – Attorney General Maura Healey announced today that her office has reached a settlement with a pediatric dentist in Springfield, returning $500,000 to the state’s Medicaid program (MassHealth) and resolving claims that the dentist improperly billed the program for services.

The settlement agreement resolves allegations that Dr. Annie Watson, DDS and her dental practice, Gentle Smiles, LLC, improperly billed MassHealth for palliative care (emergency pain treatment) between March 2010 and June 2013, and failed to comply with MassHealth rules associated with the use of that emergency treatment billing code.

The AG’s Office began an investigation into Dr. Watson and Gentle Smiles upon a referral from MassHealth, which identified Dr. Watson as the top biller of the palliative care code among all MassHealth dental providers.

Palliative care is the emergency treatment of dental pain that relieves the pain but is not curative and can include draining of an abscess or prescribing pain medication or antibiotics. In order to bill this code, the patient’s dental record must contain a description of the treatment provided and must document that the treatment was given on an emergency basis.

The AG’s investigation revealed that Dr. Watson routinely billed for palliative care without any supporting documentation, including when patients only received cleanings and x-rays.

Under the terms of the civil settlement, Dr. Watson and her business will pay MassHealth $500,000 as restitution for improper billing. The settlement also requires that Dr. Watson and her employees review and comply with all applicable state and federal statutes, and all regulations governing participation in MassHealth.

MassHealth provides healthcare products and services to eligible low-income individuals, including people with disabilities, children and senior citizens.

This matter was handled by Managing Attorney Lee Hettinger and Investigator Deborah El Majdoubi, both of the AG’s Medicaid Fraud Division. MassHealth assisted in this investigation.

TRENTON – Attorney General Christopher S. Porrino and the Office of Insurance Fraud Prosecutor announced today that an Essex County pediatrician has been sentenced to three years in state prison for submitting fraudulent claims to the Medicaid Program through which she falsely billed for working 24 hours or more a day.

Ibilola Ighama-Amegor, 55, whose Quality Pediatrix practice is located in Newark, must also pay $216,000 in restitution under a sentence handed down by Superior Court Judge Michael Petrolle in Newark on Friday.

Following a five-week jury trial in June, a jury found Amegor guilty of 48 counts of health care claims fraud and one count of Medicaid fraud, all in the third degree. Amegor was acquitted of second-degree theft by deception.

Deputy Attorneys General Crystal Callahan and Dennis Kwasnik tried the case for the Office of the Insurance Fraud Prosecutor’s Medicaid Fraud Control Unit.

“Dr. Amegor used her medical degree as a license to steal from a program that pays for medical care for the elderly and those who can’t afford health insurance,” said Attorney General Porrino. “She doesn’t belong in the medical profession, she belongs in prison, which is right where she’s going.”

“Doctors who file false insurance claims undermine the integrity of a system that depends on the trustworthiness of licensed professionals,” said Acting Insurance Fraud Prosecutor Christopher Iu. “Dr. Amegor’s sentence sends a powerful message that medical professionals who commit insurance fraud will be held accountable for their greed.”

At trial, the state presented testimony that Amegor submitted bills for 24 hours or more of work on 48 dates of service between April 30, 2008 and May 16, 2011. An investigation by the Office of the Insurance Fraud Prosecutor determined that Amegor’s practice was only open for approximately eight hours per day, three days a week.

Deputy Attorneys General Callahan and Kwasnik were assisted at trial by Detectives Janet Amberg and Janet Thai. Detective Kylie Mattis, analyst Elizabeth O’Brien, Detective Ron Allen, Detective Laura Parisi, and Senior Management Assistant B’leia Williams all testified at trial. The investigation was coordinated by Detectives Kylie Mattis and Laura Catizone, and analyst Elizabeth O’Brien. Acting Insurance Fraud Prosecutor Christopher Iu thanked the Medicaid Fraud Division within the State Comptroller’s Office and the Special Investigations Unit at Anthem (formerly Amerigroup) for referring the matter to the Office of the Insurance Fraud Prosecutor.

Acting Insurance Fraud Prosecutor Iu noted that some important cases have started with anonymous tips. People who are concerned about insurance cheating and have information about a fraud can report it anonymously by calling the toll-free hotline at 1-877-55-FRAUD, or visiting the Web site at www.NJInsurancefraud.org. State regulations permit a reward to be paid to an eligible person who provides information that leads to an arrest, prosecution and conviction for insurance fraud.

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July 11, 2017

Defendants Charged with Routinely Overbilling MassHealth, Falsely Billing for Unauthorized Services that Were Never Provided

BOSTON – The owner of a Boston-based home health agency and an employee have been arrested in connection with allegedly stealing nearly $2.7 million from the state’s Medicaid program (MassHealth) by routinely overbilling and falsely billing for services that were not authorized or provided to patients, Attorney General Maura Healey announced today.

Elena Kurbatzky, age 44, of Boston, and Natan Zalyapin, age 43, of Burlington, were arrested last night by Massachusetts State Police assigned to the AG’s Office. A Suffolk County Grand Jury returned indictments charging Kurbatzky, Zalyapin and the company, Harmony Home Health Care, LLC (Harmony), on Monday.

“We allege that these defendants stole millions of MassHealth funds meant to provide health care for those in need,” said AG Healey. “My office is committed to protecting Medicaid from fraud and abuse.”

Kurbatzky and Zalyapin were arraigned in Suffolk Superior Court today where they pleaded not guilty to the charges. Zalyapin was released on personal recognizance and Kurbatzky was transferred to Boston Municipal Court on an outstanding warrant.

As conditions of their release, they must surrender their passports, be monitored by GPS, not travel outside of the state, check in weekly with the Probation Department, stay away from witnesses in the case, and not provide or bill for MassHealth services. They are scheduled to appear in Suffolk Superior Court for a hearing on Aug. 8.

The company will be arraigned in Suffolk Superior Court on Aug. 8.

Harmony is a home health agency located on Albany Street in Boston and Kurbatzky is the sole owner. The agency was established to provide home health services to individuals covered by the MassHealth program, including skilled nursing, home health aide visits and physical, occupational, and speech therapies. Kurbatzky and Zalyapin are both registered nurses and allegedly provided the majority of nursing services to Harmony’s patients.

The AG’s Office began an investigation after the matter was referred by MassHealth, which suspected misconduct and fraudulent billing practices.

The AG’s investigation revealed that between February 2015 and October 2016, Harmony billed MassHealth for home health services allegedly provided to 38 patients, but either provided no services to those patients or billed for more services than were actually provided.

Specifically, authorities allege that on numerous instances, Harmony billed MassHealth for nurses who allegedly provided services to several patients in different locations at the exact same time, so those services could not physically have been performed as claimed.

The defendants also billed MassHealth for services that were not authorized by physicians and, in many cases, forged physician signatures on the patient plans of care in an attempt to show the services were authorized.

The defendants allegedly billed for services never provided to MassHealth members, including instances where the company billed for home health services while members were at inpatient facilities. Kurbatzky and Zalyapin also billed MassHealth for services that were not provided while they were traveling or while Zalyapin was working at other jobs.

The defendants billed for physical, occupational, and speech therapy for the majority of Harmony’s MassHealth patients even though the services were not authorized by the patients’ physicians and Harmony did not employ licensed therapists to perform the alleged services.

Kurbatzky also allegedly made false statements or failed to disclose material facts in order to make herself eligible for MassHealth. She then allegedly billed MassHealth for services she purportedly received from Harmony that were not authorized by a physician.

Based on these various schemes, the AG’s Office alleges that the defendants defrauded MassHealth of nearly $2.7 million dollars.

MassHealth provides healthcare products and services to eligible low-income individuals, including people with disabilities, children and senior citizens.

All of these charges are allegations and defendants are presumed innocent until proven guilty.

This matter was handled by Assistant Attorneys General Jennifer Goldstein and Kevin Lownds and Investigators Christine Baker and Megan Corrigan, all of AG Healey’s Medicaid Fraud Division, with assistance from the Massachusetts State Police assigned to the AG’s Office, Victim Witness Advocate Amber Anderson, of the AG’s Victim Services Division, and the Office of the Inspector General. MassHealth provided invaluable assistance during this investigation.